Treating varicocele early may preserve fertility

Infertility is probably the last thing on teenage boys' minds. However, a new study out of Brazil suggests that early treatment of a common testicular condition could preserve future fatherhood potential for some adolescents.

Varicoceles are estimated to affect 15% of males over 15. But it is found in more than a third of men being assessed for primary infertility and in 80% of secondary infertility cases - men who were once able to father a child but are not able to do so anymore.

Although varicoceles may not be the sole cause of infertility in all those cases, the close association with infertility and apparent worsening of the effect over time suggest early surgical correction could have benefits later on, the authors note.

"Because varicocele is a progressive disease, we want to know how soon we can intervene, especially because it does not cause infertility in all men," researcher Paula Toni Del Giudice of Sao Paulo Federal University, in Brazil said. "Surgical intervention is not for everyone."

Del Giudice and her colleagues studied 21 boys between the ages of 15 and 19. They collected two semen samples before surgical correction of the varicoceles and another two samples at least three months after the varicocelectomy.


The team reported in Fertility and Sterility that two important indicators of the sperm's functional health the integrity of the sperm cell DNA and the activity of mitochondria significantly improved after the surgery.

"Surgical intervention in adolescents indicated for varicocelectomy does improve sperm functional traits that are associated with infertility in adults, so there is an important benefit in performing this surgery," said Del Giudice.

The decision of whether or not to proceed with a varicocelectomy is typically based on testicular volume as well as a conventional analysis of semen quantity and quality.

Sperm damage

The new study's additional measures of sperm damage "could represent another consideration when counselling patients and parents on whether to perform surgery," Dr Eric Seaman of the Urology Group of New Jersey, in West Orange, said.

Further, the surgery poses very little risk, according to Seaman, aside from the possibility of bleeding or infection that comes with any surgery. There is a small chance that a patient could also experience some uncomfortable post-operative fluid retention around the testicle, he said.

The total costs of undergoing a varicocelectomy, including hospital services and anaesthesia, runs a few thousand dollars and is typically covered by insurance.

Still, Seaman does not suggest that parents need to rush their teenage sons into surgery. "If it sits a month, nothing will happen," he said. "A year could be another story."

"We feel that all young boys should be referred to a urologist for a full clinical evaluation, just as girls are referred to their gynaecologists," added Del Giudice. "Not all adolescents will have a varicocele, and not all adolescents with a varicocele will need an operation."

(Reuter’s health, Lynne Peeples, November 2010) 

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